Increased non-health care spending associated with lower infant mortality
An increase in state and local government non-health care spending on social and environmental services was associated with a reduction in infant mortality among some high-risk populations, study results in Pediatrics showed.
Neal D. Goldstein, PhD, MBI, assistant research professor of epidemiology at Drexel University, and colleagues conducted a longitudinal, repeated-measures study using state-level data on infant mortality and local spending from 2000 to 2016.
They theorized that three specific categories would have the greatest impact on infant mortality — educational services, social services and environmental and housing services.
From 2000 to 2016, infant deaths per 1,000 live births ranged from 3.5 in Vermont in 2016 to 13.7 in Washington D.C. in 2005. Overall, the mean was 6.6 deaths per 1,000. The infant mortality rate was more than double among Black infants (mean, 12.2 per 1,000) compared with white (5.5), Asian (5.1) or Hispanic (6) children.
“The public health implications demonstrate just how important it is that we focus on upstream factors — the so-called social determinants — of health in addition to spending money on traditional health care services,” Goldstein told Healio.
According to the study, a $0.30 increase in environmental spending per person was associated with a decrease of 0.03 deaths per 1,000 live births (95% CI, –0.04 to –0.01), whereas an increase of $0.73 per person in social services was associated with a decrease of 0.02 deaths per 1,000 births (95% CI, –0.04 to –0.01).
“Our article revealed a clear association between investment in these non-health care categories of spending and reduced infant mortality,” Goldstein said. “We hypothesize that investing in these areas improves the environment and access to important resources that are critical for health.”
Infants born to mothers aged younger than 20 years benefitted the most from increased spending in environmental and social services compared with any other age group, the authors reported. A $0.30 increase in environmental spending per person was linked with a decrease of 0.08 deaths per 1,000 live births (95% CI, –0.13 to –0.03), and a $0.73 increase in social spending per person was associated with a decrease of 0.06 deaths per 1,000 live births (95% CI, –0.10 to –0.02).
In a related editorial, Woodie Kessel, MD, MPH, professor of family science at the University of Maryland, and colleagues said the data quantifies the benefit of investing in factors that affect infant mortality.
“The United States spends more per capita on health care than any other country in the world, and we outperform many of our peer countries in preventive measures,” Kessel wrote. “Yet we lag behind most other industrialized nations in both infant mortality, in which we rank 22nd, and maternal mortality, in which we rank 48th.”